STORY ARCHIVE

Premenstrual Syndrome

TRANSCRIPT

Dr Jonica Newby reports on a new therapy for women who experience difficulties due to PMS. The recent discovery that the monthly fall in progesterone levels are accompanied by a rise in the mood changing hormone allopregnanolone, has led to a new way of taming the monthly monster - by the controlled administering of a commonly prescribed antidepressant.

NARRATIONDoes this sound like you or your loved one - lovely woman, kind to kittens, but once a month, replayed by evil twin.

Dr Jonica NewbySo what's the worst thing you ever did with PMS?

WomanI remember I sort of smashed the bannisters, because I was …

Dr Jonica NewbySmashed the bannisters?

WomanYeah, I was really frustrated about something.

WomanMobile phone.

WomanPhotograph.

WomanAh … cups, plates, ah ...

Young manShe just moons all the time.

WomanRipping out a kitchen. Does that count? The whole kitchen - plumbing, cooker and everything. So now I have no water, no cooker, or anything.

Dr Jonica NewbyFor something that's so common and so potentially destructive, I can't believe how little science has looked at pre-menstrual syndrome. But I'm pleased to report that's changing.

NARRATIONWhich is why I'm here in Birmingham, to find out what goes so wrong in the brain once a month, and how potentially to fix it. This is Birmingham University, where I'm getting ready to meet some rats, with PMS.

Dr Jonica NewbyHow can you tell ...

Dr Thelma LovickWell ...

Dr Jonica NewbyDon't tell me - they act a bit ratty?

Dr Thelma LovickThat's really bad. No, what we do, is we put them into a situation where they're slightly stressed.

Dr Jonica NewbyYeah?

Dr Thelma LovickThen we have a look and see what they do.

Dr Jonica NewbyAlright. Shall we?

Dr Thelma LovickYes.

NARRATIONRats prefer small, dark places. So to explore, they have to brave an open space. Fine on a good day. But when they're pre-menstrual, well, as Thelma found, they just want to stay in.

Dr Jonica NewbySo once a month, they just go, 'Ah!'

Dr Thelma LovickOh, once every four days in rats.

Dr Jonica NewbyOnce every four days. A period every four days, how do you like that? I'm glad I'm not a rat.

NARRATIONIn fact, rats don't get periods. But they do have a similar hormonal oestrus cycle, which meant scientists like Thelma at last had a way of seeing what happens to female hormones inside the brain. We've long known falling progesterone precedes PMS, but we didn't know is that the real culprit is its breakdown product, Allopregnanolone, or ALLO for short. So here's what we now know can go wonky once a month:

Dr Jonica NewbySo we're inside your brain now, this is a nerve ending, and these are all your stress responses - the chemicals that ramp up your emotions. Now normally they have a dampener on them. An inhibitory chemical called GABA. And here comes ALLO, ALLO helps GABA, just keeps everything calm. And then, once a month, just before your period, progesterone drops. So ALLO suddenly drops, GABA has to struggle all on its own, and then all of a sudden, there's nothing keeping those stress responses in check.

NARRATIONIn other words, the brain's emotional responses are briefly primed to over-react - fight or flight, anger or deep depression.

Dr Thelma LovickWe become hyper-responsive to quite trivial stress.

NARRATIONAnd in some women, the over-reaction is extreme.

Debbie DawsonWe had a dinner party, and we were clearing the table, and he was starting to put things in the dishwasher. And I said to him, 'I'll sort the dishwasher out,' because it is a common fact - we all know that men can't load dishwashers. And he carried on, and I was getting really angry. So I just picked up the nearest thing, and I just threw it at him. Ah, and it literally skimmed his ear, and stuck in the washing-up bowl. He looked back, you know and you think God, that was, that could have been really, really dangerous.

NARRATIONDebbie Dawson runs her own hairdressing salon. But not long ago, she was so close to losing everything.

Debbie DawsonFell out with a lot of people, fell out with family, fell out with friends. Horrible things coming out of my mouth. But there was no remorse. I didn't, wasn't really bothered that I was being horrible.

NARRATIONHow many times do I have to tell you? I tell you over and over and over …

While fifty per cent of women get multiple PMS symptoms, around five per cent get disabling PMS - mood swings so serious they're categorised as PMDD.

Professor Susan DavisCome in.

Dr Jonica NewbyThank you.

NARRATIONAnd if they're lucky, they eventually find their way to someone like hormone specialist, Professor Susan Davis.

Professor Susan DavisOkay, so the question is … A lot of the women I see are very extreme cases, because often they've seen a number of different health-care professionals before they get to me, and they're at their wit's end.

Dr Jonica NewbySome PMDD sufferers have even been misdiagnosed as having depression or bipolar disorder.

Professor Susan DavisI think people have trivialized in the past hormonal problems in women. I think also what happens is that a lot of women do deny that this is happening to them. And it's only when something really catastrophic happens, when they pick up a child and shake their child, that they realize they have to actually do something.

NARRATIONDebbie still had no idea what was wrong when her second husband told her he was leaving. And finally, someone referred her to a gynaecologist.

Debbie DawsonI was only with the gynaecologist twenty minutes, and instantly she said, 'I know what's wrong with you.' And of course then, I sat when I got home for hours, going back over four years of diaries, and the pattern was unbelievable. You know, I could turn the page and know I'm going to say on this page I was evil, turn the page and there it was - evil, literally a week before my period.

NARRATIONIt was a startling revelation for her, but what she decided to do about it will startle you even more. She decided to have her ovaries removed, and the hormones along with them. But if scientists are getting new insights into what's causing the monthly madness, is it opening up new ways to fix it?

Dr Thelma LovickNow I thought, when ALLO falls in the brain, what if we could give a drug that would raise it temporarily. And then in the literature, I came across a really, it was a really exciting fact, that the compound called Fluoxetine which is really a very well-known anti-depressant, has property of raising brain ALLO levels. And it does it very quickly.

NARRATIONYou know this drug, it's Prozac. In fact, Prozac has been prescribed for PMDD for years. Indeed, our bannister-smashing friend was put on it. But there are some serious side effects, not least of which are personal.

WomanKills your libido. Yeah, my husband would get a bit upset.

Professor Susan DavisAbout forty per cent of women treated with anti-depressants will experience loss of libido, loss of arousal, um, loss of ability to have an orgasm.

WomanBut I just thought, well I'm better off to be a reasonable person for sort of twenty-seven days of the month than you know, be able to have sex a few times, a few times, you know.

NARRATIONBut here's what's so neat about what Thelma tried. She delivered the Prozac at a twentieth of the normal dose, and only on the day her rats normally got PMS, and completely prevented their symptoms. Even more exciting, the dose was so low, it wasn't even affecting serotonin, implicated in depression.

Dr Thelma LovickI don't think it's treating the depression at all. And the reason for that is that the dose of Fluoxetine that we need to raise brain ALLO levels is about a tenth of the dose that we need to affect the serotonin systems. And of course, at such low doses, of course it should be very, very safe.

NARRATIONMeanwhile, over in Melbourne, Professor Davis has already been experimenting with intermittent doses a quarter of those recommended for PMDD, and it usually works.

Professor Susan DavisTo general practitioners watching this, I'd be saying um, don't give up. Try using the lowest dose you can titrate down to. So the lowest dose you can break the pill into. And see if you get a benefit with that. NARRATIONAnd what about Debbie, who'd taken the extraordinary step of having her ovaries and uterus surgically removed?

Debbie DawsonBy the time I came out of hospital, I felt a different person. It was overnight, literally. It was unbelievable. It was like the end of a long, long period of heartache really, had come to an end, literally. Yeah, it was brilliant.

Dr Jonica NewbyWe're all different, and there's never going to be a one-size-fits-all solution. But the more we understand about the physiology of PMS, the better chance we'll have of putting the lid on that monthly madness.

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YOUR COMMENTS

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Sharon - 19 Jul 2011 2:39:54pm

I just watched this on the recommendation of a health professional. This illness is not to be triviallised. I have estrogen dominence (not mentioned) and it has systematically destroyed my life, my reputation, my relationships. The sad part is that the medical profession know and understand this exists and yet as was the case for me told me I had to learn to live with it. If I had listened I would be dead by now. Hardly something to be glossed over in nine minutes of light entertainment/info story. In public it seems to be a joke. In private the sysmptoms lead to absolute despair. Luckily there is alot of information out there that you can find. The first hurdle is knowing what is the cause of the PMS. It isn't the same for everyone and not touched on by your program.

Peter - 27 Jun 2011 9:39:23am

A woman that means a lot to me has these the symptoms exactingly as described in your program. For that one week a month the words that would come out of her mouth were like acid to me. If I brought the subject up at other times she would denied that her moods would swing like this. In the end I became afraid of having a discussion with her, I never new if I was going to get told off.It seemed she only did it to me the person she loved.Do these mood swings carry into menopause, that is what I would like to know?

Ellie - 24 Jun 2011 3:21:54pm

Obviously Dr Newby has never suffered from PMS, much less PMDD, or she wouldn't have been so jovial in her report! Please, for the 5% of women suffering from this disorder, take it a bit more seriously. Otherwise you just come across as someone who pats a sufferer on the head saying "oh don't worry about her, she's just PMSing again".

Juliette - 24 Jun 2011 9:22:56am

Well deserved health/science topic. As a woman who has experienced mild to severe PMS since the age of 15 [31 years ago], endometriosis and Major Depression, the SSRI [fluoxetine (Prozac)] link is particularly interesting. Although dramatically and visually interesting, I found the representation of a woman with PMS as a 1950's style hysterical housewife, a tad condescending. A short comment on the potential negative health consequences of a premenopausal woman removing both her ovaries, would have been helpful too. Thanks for the segment!

This is me - 23 Jun 2011 11:22:52pm

I cannot believe that someone has taken the time to finally report on the condition that rules my life. It affects everything.Currently I am on natural Progesterone cream from Day 7 onwards with some effect. This has been a relief after 2 long years of hell. I have been given and tried the other antidepressants with no real effect, and one made it considerably worse.

I'm still not where I want to be though, and I am continually looking for answers. I am 39 and this condition is debilitating at certain times of the month. I dread knowing "its" around the corner. I also feel like a fool most of the time, because it seems so lame to be "just" suffering from a form of PMS.

My husband has been there through a lot of bad times and has watched Catalyst with me because we both knew this special report was on. He thoroughly understands what this could mean for me and our relationship to have some relief from PMDD.

I am off to my current GP (who has been a godsend) to talk to her about this report and new recommendations regarding Prozac. A female GP originally dismissed my suggestion that I thought my hormones could be to blame for my terrible mood swings, anger, irritability and sudden onset of depression. I am so glad I never went back to her.

Kylie - 26 Jun 2011 1:55:24pm

Hang in there 'This is me'...you're not alone and you're not a 'fool'. PMT and PMS and PMDD rule/affect a lot of women's lives, mine also. It's really nice to read that your husband is supportive, what a wonderful man. Stay strong girlfriend! Kylie

Cilla deLacy - 18 Jul 2011 4:00:33pm

I was soooooo relieved to finally be diagnosed with a legitimate illness but I agree that it is so hard to convince others it is a legitimate illness. It has affected my personal and professional life to a great degree but since I have been on Fluoxetine, Vitamin B6 and omega 3's I have felt better. But it is a constant battle and I am sooo lukcy to have a wonderfully supportive husband. I'd love to set up a support group because it can be a very lonely illness if no one understands it. Does anyone else want to join an online support group?

Susan - 23 Jun 2011 8:35:28pm

What is the dosing administration and the drug?

Moderator: Hi,The name of the drug is Prozac. I suggest you consult your GP regarding the dose.Thanks for watching Catalyst.

Kate Ingham - 23 Jun 2011 8:11:47pm

rather than side effected drugs, I found that taking plant hormones - phytosterols (Plus is the product I use)plus omega 3's....this dramatically my capacity to cope and immediately removed my PMT which used to hit me monthly 3 days before the event. As soon as I started taking this stuff - no PMT, no crying moments, no drama, no migraines, no bloating - i was so unused to not having a major lead up to my periods - I used to get caught out. Suggest people explore the non toxic option prior to going the drug route.

Sharon - 07 Nov 2011 12:51:29pm

I loved seeing this show. I have suffered PMDD so severely that for years I was diagnosed with bi-polar disorder and ordered to take 100's of mood altering drugs. When I got pregnant my symptoms disapeared and my psychiatrist admited they had made a mistake. Please all you ladies, look up health and diet advice, it is hard to stick to the diet at first, by well worth the cost and hard work as it works!! Good luck. Foods to avoid: sugar, preservatives, milk if it isn't organic and colours, additives ect. I couldn't believe the changes food and excercise made.